Provider Demographics
NPI:1780832543
Name:QUEEMAN, SHANIKA MCCLAIN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SHANIKA
Middle Name:MCCLAIN
Last Name:QUEEMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SHANIKA
Other - Middle Name:MONE'T
Other - Last Name:MCCLAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1494 HAMPTON VIEW COURT
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-4094
Mailing Address - Country:US
Mailing Address - Phone:440-502-7997
Mailing Address - Fax:
Practice Address - Street 1:1494 HAMPTON VIEW COURT
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-4094
Practice Address - Country:US
Practice Address - Phone:440-502-7997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004369225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist